The goal of this work was the comparison of the diagnostic eff ectiveness of the Alvarado score and the clinicosonoscopic acute destructive appendicitis score (CSADA score) in a prospective-retrospective study of 336 patients. CSADA score showed statistically signifi cant better sensitivity 96,9 %, specifi city 80 % and accuracy 88,2 %. It has lower «grey zone» (3,6 %) and less cases of missed destructive appendicitis (2,5 %).

Aim. To compare the immediate and long-term results of robot-assisted and open resection of the liver and bile ducts for portal cholangiocarcinoma.Materials and methods. The retrospective study was based upon the results of open and robot-assisted resections in 2013–2021. Patients without signs of the tumor invasion into the great vessels requiring resection and reconstruction were selected for the robot-assisted resection of the liver and bile ducts. Propensity score matching was carried out within the immediate environment in the ratio 1:2 for five covariates.Results. The results of 147 open resections of the liver and bile ducts and 17 robot-assisted resections were compared. After propensity score matching, the authors compared 33 open and 17 robot-assisted resections. Before and after propensity score matching, statistically significant differences were obtained only in the longer duration of robotassisted resections. Right hepatectomy and caudal resection were performed more frequently in the group of patients with robot-assisted interventions, but without significant differences. The authors noted a tendency to a higher frequency of R0 and a lower 90-day mortality rate after robot-assisted interventions, with no differences in the rate and nature of complications, as well as in duration of hospitalization. Survival did not differ before and after propensity score matching. After open and robot-assisted interventions the overall five-year survival rates before propensity score matching were 32% and 67%, after propensity score matching the overall four-year survival rates accounted for 62% and 63%.Conclusion. Analysis of the first experience shows a tendency to improve some immediate outcomes without worsening survival. Robot-assisted resection of the liver and bile ducts can be applied, without limitation of oncologic principles, in selected patients with portal cholangiocarcinoma if the resection is performed in specialized hepatological centers, where specialists have experience in minimally invasive surgery.

Gastric stasis constitutes a common complication of pancreaticoduodenal resection, which is insufficiently covered in Russian literature. The paper considers issues pertaining to terminology and the current classification of gastric stasis. The possibilities of preventing this complication are discussed from the perspective of evidence-based medicine.

Aim. Analysis of the results of the application of the modified step-up approach in the treatment of infected pancreatonecrosis in a third-level hospital.Materials and methods. The study included 52 patients over 18 years of age with acute pancreatitis and suspected or proven infection with pancreatic or peripancreatic necrosis .The control group included 27 patients who underwent primary open necrectomy. The comparison group included 25 patients who underwent surgical treatment within the framework of the modified concept of the stepwise surgical approach (Step-up). In the groups compared mortality rates, early postoperative complications (IIIb-IVb grade Clavien-Dindo), late postoperative complications (ventral hernias, pseudocysts, diabetes mellitus), the duration of inpatient treatment, and the duration of treatment in the intensive care unit. The indicator "Full return to primary social activity after treatment" was also proposed.Results. In the Step-up approach group, in comparison with the control group, there was a decrease in the overall incidence of postoperative complications of IIIb-IVb grade Clavien-Dindo (24% and 51.9%, respectively, p <0.05), the frequency of arrosive bleeding (0% and 14 , 8%,  respectively, p <0.05), the need for necrsequestrectomy (64 and 100%, respectively, p <0.01), the total average duration of treatment in the intensive care unit (3.2 ± 0.6 and 9.2 ± 1.6 days, respectively, p <0.05), and the average duration of treatment in the intensive care unit after execution of necrosectomy (1,4±0,4 7,2±1,3 days, respectively, p<0.01).  A complete return to social activity in the control group was noted only in 10 (37%) patients compared with 19 (76%) in the Step-up group (p <0.01).  In the Step-up group, in comparison with the control group, a tendency towards a decrease in mortality was revealed (16% and 34.5%, respectively, p> 0.05).Conclusion. The step-up approach can improve the results of treatment of infected pancreatic necrosis. The most important advantage of this concept is reproducibility - that is, the possibility of using it not only in the leading metropolitan clinics, but also in the regions of the Russian Federation. The step-up approach, however, has not yet acquired a complete form, and there is room for improvement.